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Clinicians may not adhere to guidelines for measuring FFR in intermediate stenoses
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New data suggest that clinicians with low levels of experience measuring fractional flow reserve are less likely to employ that measurement strategy than those with higher levels of experience.
Researchers of the study aimed to assess the extent to which clinicians treating patients with stable CAD adhere to guidelines recommending measurement of FFR in intermediate coronary stenoses when demonstration of ischemia by noninvasive testing is not available. They used a web-based platform to conduct the International Survey on Interventional Strategy.
The researchers queried 495 interventional cardiologists on their experience in the field. Data for 4,421 lesions were included. They then provided the participants with five complete angiograms with only focal intermediate stenoses. FFR and quantitative coronary angiography values were known to the researchers but were not disclosed to the participating clinicians.
For each lesion, clinicians were asked to determine the significance of the stenosis. Clinicians were required to select quantitative coronary angiography, IVUS, optical coherence tomography or FFR in cases of uncertainty.
Results indicated that in 71% of the decisions made, clinicians relied only on angiographic appearance, which differed in 47% of cases from the known FFR utilizing a cutoff value of 0.80.
Participants requested FFR in 21% of cases and imaging modalities in 8%.
The frequency of angiogram-based decisions decreased among clinicians with more FFR experience. Clinicians with the lowest level of FFR experience made angiogram-based decisions 77% of the time compared with 67% among clinicians with the most FFR experience. Similarly, requests for FFR were more common among physicians with the most vs. least experience with this measurement (28% vs. 14%). Rates of discordant decisions also decreased from 51% in the most experienced group to 43% in the least experienced group.
“The findings confirm that, even when all potential external constraints are virtually eliminated, visual estimation continues to dominate the treatment decisions for intermediate stenoses, indicative of a worrisome disconnect between recommendations and current practice,” the researchers concluded.
Disclosure: The researchers report financial disclosures with St. Jude Medical and Volcano Corporation.
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